Alcohol Worse than Heroin, U.K. Group Says

Among all drugs of abuse, alcohol is the most harmful overall by a wide margin, a British physician group declared.

by John Gever John Gever,Senior Editor, MedPage Today
November 01, 2010

Among all drugs of abuse, alcohol is the most harmful overall by a wide margin, a British physician group declared.

Among 20 prescription and illicit drugs that are frequently abused, the nongovernmental Independent Scientific Committee on Drugs (ISCD) determined that, for users, alcohol is not quite as dangerous as crack cocaine, heroin, or methamphetamine, but it is far more damaging to others.

The committee's review, published online in The Lancet, gave alcohol an overall "harm score" of 72. Heroin came in second with a score of 55, with crack cocaine a close third at 54.

Tobacco -- often considered the most dangerous popular drug of all -- scored only 26 on the group's scale, sixth overall.

Led by David J. Nutt, PhD, of Imperial College in London, the group noted that their findings echoed conclusions of two earlier systematic reviews by groups in the U.K. and the Netherlands.

They used their results to attack the current drug classification scheme in Great Britain -- and most other Western countries -- that leaves alcohol only minimally regulated while drugs far less harmful to the general populace such as LSD (18th out of 20) are illegal, and others such as methadone (10th) and buprenorphine (19th) are available only under highly restrictive prescription programs.

"The present drug classification systems have little relation to the evidence of harm," Nutt and colleagues wrote.

The group added that their findings "accord with the conclusions of previous expert reports that aggressively targeting alcohol harms is a valid and necessary public health strategy" -- although they recommended no specific anti-alcohol measures.

The ISCD's analysis was based on a model that incorporates scientific data on nine types of harm to users and seven affecting others.

The user-specific harms include mortality and injury, psychological effects such as dependence, and impacts on social functioning.

Harms to others included physical injury plus a range of social impacts, such as crime, negative effects on family members, and economic costs.

Some of the data in the latter category were specific to Great Britain, but in general it appeared their analysis would apply to the U.S. and other developed nations.

Each criterion was scored on a 100-point scale, with 100 assigned to the drug with the worst harm in that category. A weighting system was then applied, based on comparisons across all criteria for the drugs scoring 100 on one or more of them, to reflect the fact that some drugs with 100-point scores are more harmful than others.

The result was that harms to others accounted for most of the differences between drugs at the most-harmful end of the overall spectrum.

In fact, only three of the 20 drugs analyzed were found to be substantially harmful to people other than the user: alcohol, heroin, and crack cocaine.

Scores for harm to others were 46 for alcohol, 21 for heroin, and 17 for crack. Tobacco was a distant fourth, with a score of nine.

In terms of harm to users, methamphetamine, heroin, and crack were bunched together at the top, followed by alcohol, powder cocaine, tobacco, amphetamine, and the sedative-hypnotic drug GHB.

The least harmful drug overall was psychedelic mushrooms, with zero harm to others and a score of six for harm to users. Marijuana had an overall score of 20, eighth overall.

However, the analysis did not include oxycodone or other prescription opioid painkillers that are commonly abused in the U.S.

The ISCD is headed by Nutt and comprises 23 researchers and medical professionals, most of whom hold university appointments in Britain, with expertise in drug abuse. They recruited two additional researchers "with specialist knowledge of legal highs" to help with the current analysis.

The group's stated purpose is to "investigate and review the scientific evidence relating to drugs, free from political concerns" and to make the findings publicly available.

Nutt had previously expressed views similar to those documented in the ISCD report while he was chairman of the British government's advisory committee on drug abuse. He was dismissed last year by the Home Secretary, who said he had improperly crossed the line separating scientific analysis from advocating specific policies.

In a defense published in the New Scientist, Nutt wrote, "If there is one thing that politicians can and should do to limit the damage caused by illegal drugs, it is to take careful note of the evidence and develop a rational drug policy. Some politicians find it easier to ignore the evidence, and pander to public prejudice instead."